Community EHR Program – Frequently Asked Questions
This document provides answers to physicians and other community members for frequently asked questions about the North Shore-Long Island Jewish Health System (NSLIJHS) Community EHR Program.
Vision
Why is North Shore-LIJ Health System (NSLIJHS) launching an EHR?
NSLIJHS is committed to the improvement of health in the community of greater than 5 million people it serves. An EHR enables the right people to have the right information at the right time in order to:
- Facilitate coordination of care and communication across practitioners
- Improve the quality of care and the overall patient experience
- Connect patients and practitioners in the community
- More effectively manage entire “episodes of care” across practitioners and care settings
- Support participation in quality-of-care initiatives
How does this initiative tie into National Healthcare Reform?
The Obama administration believes that healthcare quality can be improved and costs can be reduced through the use of interoperable healthcare IT. An interoperable healthcare IT infrastructure enables practitioners to communicate more effectively, thereby rendering higher quality care as well as eliminating redundant testing for patients seeing multiple practitioners.
How will this initiative be funded?
NSLIJHS has negotiated discounted pricing for physicians with a leading EHR software company for the software, installation, and ongoing support. NSLIJHS will also provide a subsidy to physicians. The NSLIJHS subsidy is included in the health system’s capital plan, which is approved by the Board of Trustees.
In addition, the EHR will enable eligible physicians to obtain funding from the Federal Stimulus Program’s Healthcare Information Technology (HITECH) Act. The HITECH Act provides incentive payments via Medicare to physicians who adopt an electronic health record and who demonstrate that they are using it according to standards set by the federal government.
What is the benefit to patients?
An EHR has embedded ‘best-practices’, care guides, and/or decision support & alerts that can improve the clinical performance of clinicians by reminding them of necessary monitoring for patients with chronic diseases, identifying opportunities for preventive care, and preventing medical errors by checking for drug interactions or other dangerous conditions.
By connecting this EHR to EHRs in other care environments (e.g. hospitals) all caregivers will have access to a comprehensive set of clinical information on patients, which will support better clinical decision making.
Additionally, the EHR will eventually connect to a personal health record which will allow patients to participate more actively in healthcare decision making. As a result, patients can expect that their care will be more efficient and more effective, and more coordinated than ever before.
What are the benefits to physicians and their offices?
EHRs offer a number of benefits to the physicians’ office, including immediate 24/7 access to patient information (even when outside of the office), intra-office communication tools to improve office efficiency, tracking tools for testing which has been ordered but not completed, tracking tools for results which need to be reviewed (significant source of liability risk), more accurate and timely billing capabilities, and decreased administrative complexity.
What is the benefit to the community?
Patients will have access to a community of physicians delivering high-quality healthcare based on the latest scientific evidence and to a resource that will make their medical information fully portable.
Program
How does the Community EHR program work?
NSLIJHS will be offering two options to physicians who wish to participate – the Integrated Program and the Connected Program. Both programs provide an Allscripts EHR with embedded clinical content and data sharing with other NSLIJ care environments (e.g. emergency department, hospital). Both programs also offer a subsidy from NSLIJHS. The Integrated Program offers additional components to support participation in collaborative quality improvement activities.
What is the Connected Program?
Physicians utilize an Allscripts EHR that is approved by NSLIJHS and meets all requirements of the Federal Stimulus program. Program benefits include:
- Allscripts Enterprise EHR & Practice Management system
- Preconfigured connections to NSLIJHS hospitals, diagnostic facilities, and labs
- Onsite implementation assistance and 24/7 hosting and help desk support from Allscripts
- Qualification for Federal Stimulus by achieving “meaningful use”
- 50% subsidy from NSLIJHS
Physicians must be credentialed and privileged at an NSLIJHS facility to be eligible for the program.
What is the Integrated Program?
Physicians receive all of the same benefits as the Connected Program with the following additional benefits:
- Participation in the identification, development, and utilization of Clinical Practice Parameters (CPPs)
- Analytics integrated into the EHR to assist in monitoring and achieving optimal performance in the defined CPPs
- 85% subsidy from NSLIJHS
Physicians must be credentialed and privileged at an NSLIJHS facility to be eligible for the program. In addition, the Integrated Program requires that physicians:
- Utilize the AEHR in a way that allows electronic monitoring and reporting of the clinical variables necessary to assess the quality of care
- Agree to the monitoring of a series of clinical process and outcomes measures for a defined set of preventive and/or chronic disease management measures appropriate for the physician’s specialty and practice
When will the program be up and running?
The EHR system will go live in the 4th quarter of 2009. An initial ‘Champion’ program will work with a small group of practices who will work closely with NSLIJHS and Allscripts to optimally implement the EHR system. Successive waves of practices will be scheduled to begin installation quickly thereafter, beginning in 2010.
Integrated Program
What do you mean by Clinical Practice Parameters (CPPs)?
Clinical Practice Parameters (CPPs) are a set of guidelines and recommendations developed from leading clinical best practices throughout the country. CPPs are reviewed and validated for applicability by the Evidence Based Medicine (EBM) group. Once endorsed by clinical leaders, they are used to measure improvements in care and to provide feedback to physicians on their patient populations.
How will the CPP’s support daily clinical practice?
The Allscripts EHR includes what are called ‘CareGuides’, which will be aligned with the CPPs. CareGuides provide the clinician with a list of diagnostic tests and possible therapeutic interventions which are considered ‘best practice’ to help support optimal decision making. Once elements of the CareGuide are selected, the EHR will construct a long-term plan for ongoing monitoring of the patient based on their list of medical problems as well as standard healthcare preventive maintenance based on age/gender.
Can physicians participate in the development of the CPPs for their specialties?
NSLIJHS will encourage active participation from all specialty practices in the development of CPPs. The basis for CPPs will be the Allscripts ‘CareGuides’ that are delivered with the EHR. These CareGuides will be refined based on input from the appropriate specialties and will also be reviewed by the NSLIJHS EBM group and its subcommittees for the development of clinical performance measures.
Will there be targeted metrics established for each CPP?
Yes. Most of the metrics will be driven by currently established agencies such as CMS, NQF, IOM, and various national quality measurement agencies. Chosen metrics will be approved by the EBM and its subcommittees.
What are the benefits to clinical practice in meeting the targeted metrics?
Improved patient care and outcomes are the first obvious benefit. Embedding ‘best-practices’ within an EHR can improve the clinical performance of clinicians. Also, comparing to a large aggregate population of physicians allows for sharing of improvement activities and benchmarks for optimal care.
Moreover, participation in the Integrated Program and meeting the targeted metrics will at some point be a condition for joining Clinical Integration Independent Practice Association (CIIPA) managed care contracts.
What if a physician or practice fails to achieve the metrics?
NSLIJHS desires to help physicians provide the best care possible by facilitated CareGuides and performance measurement. Collectively, the Clinical Integration Steering Committee will determine the timeline for meeting performance targets.
The Evidence Based Medicine group, along with specialty subject matter experts, will develop more detailed guidelines for management of patients who do not clinically respond to or achieve the right physiologic targets despite use of the basic CareGuides.
NSLIJHS will not
- Share quality reports or data about any individual identifiable physicians with any third parties (e.g. payers, public reporting agencies)
- Admonish physicians for clinical circumstances outside of the physicians’ control (e.g. patient non-compliance)
Can a practice enroll in the Integrated Program if there are no defined CPPs for the specialty?
Yes. If CPP’s have not yet been defined, a practice can still enroll in the Integrated Program and will obtain the subsidy for participation. NSLIJHS would anticipate practice involvement in the CPP identification and development specific for the specialty.
Who is developing the criteria and what will be the basis?
CareGuides are developed by an Allscripts expert panel and validated by their large client base. Participants in the program will work with NSLIJHS to identify existing or locally develop more detailed guidelines for management of patients who do not clinically respond to or achieve the right physiologic targets despite use of the basic CareGuides.
Are you dictating how clinicians should treat their patients?
No. We are making it easier for clinicians to do what they already know is best clinical practice by providing reminders, alerts, and feedback on the care they provide. NSLIJHS physicians want be provide world class clinical care. This initiative will enable that desire in an organized way.
How will compliance be measured?
CPPs are intended to provide guidance to the physician. Ultimately, clinical outcomes – in the form of metrics – will be studied, irrespective of how the clinician achieved them.
Are you measuring patient outcomes in addition to compliance with the CPPs?
Measurable outcomes for the individual patient (e.g. achieving a certain measurement in a certain range) will be studied when they are available and appropriate for the disease state.
In addition, it is imperative that the clinical community focus on population-based outcome measures (e.g. percent of eligible women undergoing mammography or percent of patients with diabetes who are well controlled). Health system goals related to community health will be supported by analyzing community-level data to understand outcomes for disease complications, morbidity, mortality, etc.
How will NSLIJHS support physicians in achieving the goals and meeting the requirements of the Integrated Program?
In addition to the increased level of subsidy, NSLIJHS will support physicians by
- Overseeing a collaborative process to determine the most appropriate Clinical Practice Parameters and the expected level of performance for each clinical specialty
- Providing aggregate reports summarizing the physician’s performance around the defined clinical metrics
- Assuring that the AEHR provides the appropriate reports and reminders to help the physician identify patients whose outcomes do not meeting the defined measure
- Providing guidelines to assist physicians in the clinical decision making necessary to achieve optimal performance in the defined Clinical Practice Parameters
What other examples are there of Systems connecting the EHR with care/quality/outcomes/compliance/protocol?
Intermountain Health, Geisinger, Mayo Clinic, Cleveland Clinic.
How is the Integrated Program methodology different?
The overall scale of the program (8000 potential physicians); the high level of subsidy being offered; the mixture of employed and community physicians that can participate; and the vision for connection to the Emergency Room, Inpatient environment, and RHIO.
SUBSIDY
Which practices are you subsidizing?
All members of the NSLIJHS medical staff will be offered the opportunity to participate in the EHR initiative through either the Connected or Integrated Program. The programs provide different levels of subsidy. Physicians will need to determine which program best suits their needs.
What are the different levels of subsidy?
Physicians who enroll in the Connected program will be subsidized at a rate of 50% and those who enroll in the Integrated program will be subsidized at a rate of 85%.
How will the subsidy be paid?
The subsidy will be paid over the course of 60 months, upon signing the contract for the system. Physicians will receive subsidy payments towards the up-front installation fees as well as the ongoing monthly payments for 60 months.
Subsidy payments will be made directly to Allscripts on behalf of the physician and will be applied to the physician’s invoices from Allscripts.
What if the physician changes his/her mind?
Subsidies will stop if a physician elects to withdraw from either of the programs. The physician will have the option to continue using the Allscripts EHR at the negotiated price.
Additionally, a physician can opt out of the Integrated Program and enroll in the connected plan or vice-versa – subsidies will be adjusted accordingly.
Enrollment & Installation
What is the maximum number of physicians that can use the EHR system?
The architecture of the product is scalable. It can handle adding on as many practices as needed.
How many do you plan to enroll?
The current plan extends to 12/31/2011 and targets enrolling 1,200 physicians during that time. After this period, NSLIJHS will evaluate the status of the program offering and determine the best course of action.
How long will it take to bring everyone online?
A typical practice installing the model EHR can be completed in 2-3 months.
NSLIJHS has worked with Allscripts to develop a model EHR that will meet the needs of the majority of practices and that is differentiated by medical specialty. In addition, Allscripts has developed a highly efficient installation process that is tailored to the NSLIJHS program and EHR product.
How will you market the program and the EHR product to physicians?
Allscripts has assembled a dedicated team of field staff who will work with physicians in the NSLIJHS community. NSLIJHS is working with Allscripts to develop marketing tools include a web-site, webinars, product demonstrations, brochures, an 800 hotline as well as other resources.
How is the relationship between all of the parties structured?
A contractual agreement between Allscripts and NSLIJHS stipulates the details of the EHR product, services, and pricing that Allscripts will provide to participants in the program.
Physicians will need to sign two contracts in order to participate in the program:
- Physician-Allscripts Contract: This contract covers the sale of the EHR to the practice and the related installation, hosting and support services provided by Allscripts.
- Physician-NSLIJHS Contract: This contract outlines conditions for participation in the Connected or Integrated Program and receipt of the subsidy.
Allscripts
Why did NSLIJHS choose to partner with AllScripts?
Allscripts was chosen through an extensive evaluation process by a team of voluntary and full-time NSLIJHS physicians. The team chose Allscripts as the best fit for the health system as compared to the other leading vendors in the industry. One of the key selection criteria was to partner with a leading EHR company that shares the NSLIJHS vision for transforming healthcare. Financial strength and resources to handle the community needs were also key considerations.
Why did NSLIJHS use a different company for it ambulatory EHR than it does for its inpatient EHR?
Office-based care is very different from hospital care and requires different functionality. While the software company used for the inpatient EHR offers an outpatient system, the system is not designed for use in community-based offices.
How will the inpatient EHR and Allscripts talk to each other?
The Federal Office of the National Coordinator for Health Information Technology (ONCHIT) has placed tremendous focus on the ability of healthcare IT systems to exchange information. There are two major standards organizations which are focused on development of standards for EHRs to exchange data (CCHIT – Certification Commission of Healthcare IT, HITSP – Healthcare Information Technology Standards Panel). These standards will facilitate exchange of large volumes of patient data between EHR systems. As part of the overall program, NSLIJHS is purchasing and installing a dedicated data interchange hub to serve as the ‘broker’ of information transfer between EHR systems.